स्वास्थ्य बीमा बोर्डले बीमीतले सहज रुपमा स्वास्थ्य सेवा लिन र प्रेषण सेवालाई व्यवस्थित बनाउन नयाँ कार्यविधि समेत ल्याएको छ । शुक्रबार बसेको बैठकले स्वास्थ्य बीमा कार्यक्रममा प्रेषण सेवा सम्बन्धी कार्यविधि २०८० स्वीकृत गरी लागू गर्ने निर्णय गरेको हो ।
नयाँ कार्यविधि अनुसार अब बीमित सेवाग्राहीलाई प्रेषण (रेफर) गर्दा सेवा उपलब्ध भएको सबैभन्दा नजिकको संस्थामा गर्नुपर्ने छ । यस्तै एउटा रोगको लागि गरिएको प्रेषण सेवा सोही रोगको लागि पुनःजाँचका लागि पुन प्रेषण पुर्जीको आवश्यक नपर्ने व्यवस्था गरिएको छ ।
यस्तै आकस्मिक सेवाका लागि प्रेषण पुर्जीको आवश्यक नपर्ने, सेवाग्राहीलाई प्रेषण गर्दा त्यस ठाउँमा सेवाको उपलव्ध भएको सुनिश्चित गर्नु पर्ने, स्वास्थ्य बीमा नियमावली २०७५ को नियम (२० (२) संग सम्वन्धित अनुसूची ९ बमोजिमको प्रेषण पूर्जा अनुसारको विववरण भरी पेश गर्नु पर्ने, सेवा प्रदायक स्वास्थ्य संस्थाहरुमा उपलव्ध सेवाको व्यक्ति विशेषको मागको आधारमा रिफरल अन रिक्वेष्टलाई बीमा व्यवस्थापन सूचना प्रणालीबाट अस्विकृत गर्ने र सो बापतको भूक्तानी समेत नहुने लगायतका व्यवस्था कार्यविधिमा उल्लेख छ ।
यस्तै स्वास्थ्य बीमा सुविधा थैलीमा भएको औषधि र सेवाको मूल्य पुनराबलोकन हुने भएको छ । सुविधा थैलीमा भएको औषधिको मूल्य तथा सेवाका सन्दर्भमा हरेक तीन तीन वर्षमा मूल्य समायोजन गर्ने भनिए पनि अहिलेसम्म हुन सकेको छैन ।
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